MEDICARE: MICHAEL TRAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8423T	TX

General Provider Information

NPI Number	:	1154735934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TRAN

Provider Business Mailing Address
First Line	:	2720 WESTERN CENTER BLVD
Second Line	:	SUITE 316
City	:	FORT WORTH
State	:	TX
Zip	:	76131-4302
Country	:	US
Telephone Number	:	817-847-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 WESTERN CENTER BLVD
Second Line	:	SUITE 316
City	:	FORT WORTH
State	:	TX
Zip	:	76131-4302
Country	:	US
Telephone Number	:	817-847-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	06/19/2014

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